Who knows or ponders the articulations (joints) more so than the rheumatologist or orthopedist? We know their anatomy, their contours, tender sites and how to examine them. Adults have over 200 bones and up to 360 joints. Imagine if you had to do a DAS360?
Wine and the rheumatologist in theory could be about a lot of things. Naturally, as rheumatologists, we are interested in how wine may affect rheumatic diseases. I am more inclined to write about how our community interacts around and enjoys wine.
A slim, yoga bending, middle aged school teacher seeks a rheumatology consultation to determine the cause and cure for her left lateral heel pain for the past 6 months. No trauma, no crazy footwear and no systemic symptoms, uveitis, or peripheral/axial arthritis. Beyond inflammatory enthesopathies (Achilles tendinitis is or plantar fasciitis), the causes of heel pain are numerous.
Hydroxychloroquine is one of many medications frequently used in rheumatology practice. Its remarkable versatility is attested by its routine use in lupus, in patients with an autoimmune coagulopathy, in patients with rheumatoid arthritis, as well as those with a low-level inflammatory arthropathy. It’s an amazing medication, with a novel history and wide array of indication and multiple actions that we now better understand.
Twitter? Really?
A famous quote from Verna Wright, MD,states, “Clinicians may all too easily spend years writing“doing well” in the notes of a patient who has become progressively crippled before their eyes".
There’s a certain comfort to work that is rote, mechanistic and almost automatic. The mailman sorts his mail, delivers that mail to a well-planned route, and then circles back to collect and redirect outgoing new mail. Tuesdays schedule and tasks are the same as those done on September 14th.
What are your rules on methotrexate and alcohol use? How about casual, social or occasional alcohol use? If one alcoholic beverage is ok, what about 2, 3 or six while taking MTX? Many rheumatologists have crafted alcohol and methotrexate policies to protect patients and reduce the risk associated with coadministration of these potential hepatotoxins.
Reactivation of hepatitis B virus infection can have devastating consequences, especially amongst those patients receiving immunosuppressive therapy.
The spread of the viral infection Chikungunya continues with the CDC issuing a travel advisory for those traveling to Mexico, where over 7000 cases of the viral infection have been reported. Mexico and Central America accounts for 162,249 cases or nearly one-third of chikungunya reported in the Western hemisphere in 2015.
Adult-onset Still's posses a interestng and diagnostic challeng when encountered. Here are 5 tips to improve your diagnostic acumen for this febrile disorder.
The disease activity score (DAS28) has been developed as a dynamic assessment tool and a therapeutic response measure for use in clinical trials and practice. Although intended for use in patients with rheumatoid arthritis, its utility has been applied in the assessment of other inflammatory arthropathies.
Barry Waters, MD*: I have a 21 yr old lupus nephritis patient on mycophenolate, hydroxychloroquine and prednisone 40 mg per day. She says both her current nephrologist and her prior pediatric rheumatologist told her NOT to get pneumococcal and flu vaccines.
Researchers at Stanford University analyzed 2013 Medicare Part D prescription drug coverage claims for narcotic painkillers containing hydrocodone, oxycodone, codeine and other opioids. (Citation source http://buff.ly/1JgR2Tr)
I am often asked the question: When is the right time to taper a patient off opioids?
My view is that a patient should be tapered any time the risks exceed the benefits, or when treatment goals are not being met.
Risks of prescribing long-acting medications to patients who may be high risk for opioid addiction are a real concern -- something I've devoted much time and research to.
